Menopause

Question 1

Definition of Menopause

Answer 1

Natural menopause is defined as the permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious pathologic or physiologic cause. It occurs at a median age of 51.4 years and is a reflection of complete, or near complete, ovarian follicular depletion, with resulting hypoestrogenemia and high follicle-stimulating hormone (FSH) concentrations

Question 2

Long-Term consequences of estrogen deficency?

Answer 2

Bone Loss
Cardiovascular Disease
- Lipid profile changes
-- increase in LDL
-- decrease in HDL
Dementia (limited data)
Osteoarthritis (limited data)
Body composition
- increase in fat mass
- decrease in lean mass
Skin Changes
- reduction in collagen content of skin

Question 3

What is Menopausal Transition?

Answer 3

This change in bleeding pattern, which is accompanied by hormonal fluctuations and a variety of symptoms, is referred to as the menopausal transition, or perimenopause, and occurs on average at age 47 years
Two stages:
- Early Transition
- Late Transition

Question 4

What is the median age of Menopause?

Answer 4

51.4 years

but transition begins about 4 years before

Question 5

What is early menopausal transition?

Answer 5

a change of ≥7 days in the intermenstrual interval

• periods becoming shorter
• length of cycle increasing
• • normal: 25-35 days
• • transition: 40-50 days

Easy Answer: increasing of cycles

Question 6

What is late menopausal transition?

Answer 6

After the initial lengthening of the intermenstrual interval, women then progress to more dramatic menstrual cycle changes with skipped cycles, episodes of amenorrhea, and an increasing frequency of anovulatory cycles

Easy Answer: skipping cycles

Question 7

Signs and Symptoms of Menopause?

Answer 7

• Hot flashes/flushes (± sweating ♦ palpations), lasts 2-30min - most common Sx: 80% of women get it
• Vaginal dryness/discomfort, dyspareunia, dysuria, ↑ UTI (urogenital atrophy)
• Sleep disturbance (secondary to night sweats)
• Skin changes (thinning, | elasticity)
• Mood disorder (depression, anxiety, irritability)
• Cognitive disturbance (forgetful)
• Somatic complaints (back pain stiffness)
• Urinary incontinence
• Vertigo/Headache
• Palpitations
• Sexual dysfunction

Question 8

When do Signs of Symptoms begin and who long can they last for?

Answer 8

• Vasomotor symptoms ↑ as the stages of menopause progress
• Should start ↓ within 4 years of final menstrual period
• 10% have persistent symptoms 7-10 yrs after final menstrual period

Question 9

When and what investigations should be done in Menopause?

Answer 9

Age <45, especially <40

FSH - on day 3 of cycle (do NOT do if on OCP)
LH - increases later than FSH
TSH,
Prolactin
B-HCG
Estradiol (<20=menopause)

if pt on OCP: test 7 day of pill free time: if ↓estrogen, ↑ FSH =menopause